Reimbursement

Dennis Scanlon, PhD, professor of health policy and administration at the Pennsylvania State University, discusses how extra benefit coverage and the choice to shop for plan options are some factors driving Medicare Advantage (MA) program growth.

Using data from 632 primary care practices, the authors show that the CMS Practice Assessment Tool has adequate predictive validity for participation in alternative payment models.

Targeting everyday chronic conditions to rare diseases that require costly, sometimes 1-time treatments, CMS Tuesday announced an intent to test 3 new models in an effort to lower drug prices and widen access to expensive, life-changing therapies for patients in Medicare and Medicaid.

Rates of preventive oral health services among pediatric medical visits in Florida were similar whether visits were paid via Medicaid comprehensive managed care or fee for service.

Dennis Scanlon, PhD, professor of health policy and administration at the Pennsylvania State University, discusses some of the reasoning behind Part D benefits changes in the Inflation Reduction Act (IRA) and the cost questions that remain.

The Biden administration released 2 sets of guidance documents for pharmaceutical manufacturers about how it plans to implement the new Medicare Prescription Drug Inflation Rebate Program as required under the Inflation Reduction Act, and said some beneficiaries could see lower coinsurance for some Part B drugs as soon as April 1.

Drug costs, particularly for immunotherapies, contributed to the rising cost of care during the last 6 months of life for a fee-for-service Medicare beneficiary, according to a recent study.

In this column, a health insurance executive discusses 2 ways to address rising inflation, including moving past the traditional fee-for-service payment model.

The bill could have saved CMS about $26.5 billion had it been in place from 2018-2020, the study showed.

With the public health emergency soon coming to an end, people covered by Medicaid will encounter new barriers, discusses Dennis Scanlon, PhD, professor of health policy and administration, Penn State University.

In Canada, monthly prices were significantly different for cancer drugs with substantial clinical benefit vs low benefit.

An HHS report said that if the Inflation Reduction Act (IRA) had been implemented in 2020, Medicare Part D beneficiaries could have saved a total of $734 million, averaging out to about $500 per member.

Coverage from the 64th American Society of Hematology Annual Meeting and Exposition, held December 10-13, 2022, in New Orleans, Louisiana.

To best improve health equity, population-based payment models should both incorporate social goals and increase payment for historically marginalized communities, a recent study has found.

Creating new incentive models and transparently sharing data in a way that changes behaviors are 2 ways to reduce low-value care in the health care system, explains Ken Cohen, MD, director of translational research for Optum Care.

A survey of all Arizona physicians found that accountable care organization, clinically integrated network, or integrated delivery network participation was associated with higher use of health information exchange. However, there are exceptions and important barriers noted.

The 10 drugs selected for Medicare Part D price negotiation with HHS will be announced on September 1, 2023, HHS said Wednesday.

We want to make it easy for our patients to manage and navigate the financial toxicity they encounter from their cancer care, noted Mike Koroscik, MBA, MHA, vice president of oncology, Allina Health and the Allina Health Cancer Institute.

The top 5 pieces of content published on AJMC.com relating to reimbursement issues included 2 on the significance of a California law giving Medicare beneficiaries access to expert oncology care; other articles looked at the work involved in value-based care models and CMS news.

The top content published in The American Journal of Accountable Care® (AJAC) covered redesigning health care, value-based care, and novel payment models, like the ACO REACH model.

The most-read articles related to our Strategic Alliance Partnership (SAP) program focused on behavioral health, oncology care, and partner news.

The combined resources of CareOregon and SCAN Group’s health plan and care delivery subsidiaries, operating under the HealthRight umbrella, will have revenues of $6.8 billion and will serve nearly 800,000 health plan members.

Our current health care reimbursement system rewards procedures and undervalues the time spent talking with patients and learning their history, which speaks to the need for primary care redesign, according to Vineet Arora, MD, MAPP, dean for medical education at UChicago Medicine.

Coverage from the first day of the inaugural OneOncology Physician Leadership Conference, held November 11-13, 2022, in Nashville, Tennessee.